A meta-analysis of targeted interventions for reducing suicide-related behaviour and ideation in adolescents: Implications for trial design

INTRODUCTION Suicidality among young people is a significant societal issue. The current study conducted a meta-analysis of community and clinical interventions targeting suicide attempts, self-harm, and suicidal ideation in adolescents. METHOD Interventions targeting suicide attempts, self-harm and suicidal ideation were identified by searching PsychINFO, Medline, CINAHL and Embase in line with the PRISMA statement. Study quality was determined using a risk of bias tool. Meta-analyses examined the efficacy of the interventions. Effect sizes were calculated for suicidal ideation data (continuous data) using Hedge's g for standardised mean differences. Suicide attempts and self-harm (dichotomous data) were calculated using odds ratios (ORs). RESULTS Seventeen RCTs were included in the meta-analysis. No significant differences were found between treatment and control groups on measures of suicide attempts or self-harm. A small effect-size was observed on measures of suicidal ideation (g = 0.47). A secondary meta-analysis investigated change over time in treatment as usual conditions, finding significant large effect-sizes for suicide attempts (OR = 18.67), self-harm (OR = 12.77), and suicidal ideation (g = 0.86). LIMITATIONS The methodological decision to focus on specific outcomes over a broad definition of self-harm excluded some papers, which have been included in other reviews. It is unlikely to have significantly affected the overall results. The review was not preregistered. CONCLUSIONS These twin findings highlight the importance overcoming the methodological difficulty of discerning effective interventions during a period of baseline improvement. We suggest that future trials should move away from broadly addressing "suicidality/self-harm" and encourage a greater targeting of at-risk individuals.